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Verstraeten LMG, Kreeftmeijer J, van Wijngaarden JP, Meskers CGM, Maier AB. Geriatric Syndromes Frequently (Co)-Occur in Geriatric Rehabilitation Inpatients: Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR). Arch Phys Med Rehabil 2024:S0003-9993(24)01017-7. [PMID: 38851557 DOI: 10.1016/j.apmr.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE To determine the prevalence and co-occurrence of common geriatric syndromes in geriatric rehabilitation inpatients. DESIGN Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR) are observational, longitudinal cohorts. SETTING Geriatric rehabilitation. PARTICIPANTS Geriatric rehabilitation inpatients (N=1890 and N=200). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Geriatric syndromes included polypharmacy, multimorbidity (Cumulative Illness Rating Scale), cognitive impairment, depression (Hospital Anxiety and Depression Scale/Geriatric Depression Scale), malnutrition (Global Leadership Initiative on Malnutrition), functional limitation (Katz index), falls, physical frailty (Fried), and sarcopenia (European Working Group on Sarcopenia in Older People 2). RESULTS Inpatients in RESORT (R) (N=1890, 56% females) had a median age of 83.4 years (interquartile range [IQR], 77.6-88.4) and in EMPOWER-GR (E) (N=200, 57% females) of 79.8 years (IQR, 75.0-85.9). Polypharmacy (R, 82.2%; E, 84.0%), multimorbidity (R, 90.4%; E, 85.5%), functional limitation (R, 96.0%; E, 76.5%), and frailty (R, 91.8%; E, 92.2%) were most prevalent. Most inpatients had ≥5 geriatric syndromes at admission in both cohorts (R, 70.0%; E, 72.4%); few inpatients had only 1 (R, 0.4%; E, 1.5%) or no geriatric syndrome (R, 0.2%; E, 0.0%). Geriatric syndromes did not occur in isolation (without other syndromes), except for multimorbidity (R, 1%; E, 5%), functional limitation (R, 3%; E, 2%), falls (R, 0%; E, 4%), and frailty (R, 2%; E, 5%), which occurred in isolation in some inpatients; sarcopenia did not. CONCLUSIONS Geriatric syndromes are highly prevalent at admission to geriatric rehabilitation, with a median of 5 co-occurring syndromes. Implications for diagnosis and intervention potential should be further addressed.
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Affiliation(s)
- Laure M G Verstraeten
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jos Kreeftmeijer
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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Perrella AJ, Karimi A, Reppas-Rindlisbacher C, Lee J, Wong E, Patterson C. Associations Between Patient Characteristics and Unplanned or Delayed Discharges From Geriatric Rehabilitation: A Retrospective Chart Review. Am J Phys Med Rehabil 2023; 102:1111-1115. [PMID: 37594216 DOI: 10.1097/phm.0000000000002327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
ABSTRACT Returning home is considered an indicator of successful rehabilitation for community-dwelling older adults. However, the factors associated with unplanned discharge remain uncertain. This retrospective chart review included patients 65 yrs and older admitted to a geriatric rehabilitation unit from medical and surgical wards in an academic hospital. Patient characteristics and outcomes were abstracted from the electronic medical record. The primary outcome was unplanned discharge destination defined as anything other than return to patients' preexisting residence. The associations between patient variables and unplanned discharge destination were analyzed using Pearson χ 2 and univariate logistic regression. Of the 251 charts screened, 25 patients (10.0%) had an unplanned discharge destination, and 74 of the remaining 226 (32.7%) experienced a delayed discharge (beyond 20 days). Requiring assistance for activities of daily living (odds ratio [OR], 2.80; 95% confidence interval [CI], 1.17-7.47), a diagnosis of chronic obstructive pulmonary disease (OR, 4.04; 95% CI, 1.63-9.71), and lower serum albumin level (OR, 1.67; 95% CI, 1.06-2.72) were associated with unplanned discharge. Variables commonly associated with worse outcomes such as age, cognitive scores, delirium, and number of comorbidities were not barriers to returning home and should therefore not be used on their own to limit access to geriatric rehabilitation.
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Affiliation(s)
- Andrew J Perrella
- From the Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada (AJP, JL, CP); Department of Medicine, University of Illinois Chicago, Chicago, Illinois (AK); Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada (CR-R, EW); Division of Geriatrics and Internal Medicine, Sinai Health, Toronto, Canada (CR-R); and Division of Geriatric Medicine, Unity Health, Toronto, Canada (EW)
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Owari G, Kono K, Kanouchi D, Uchiyama M, Nishida Y. Association between depressive symptoms and heart rate variability in older patients admitted for rehabilitation: a cross-sectional study. Int J Rehabil Res 2023; 46:248-251. [PMID: 37417800 DOI: 10.1097/mrr.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Heart rate variability (HRV) is associated with depressive symptoms, but this relationship in older inpatients undergoing rehabilitation remains unclear. This study investigated the relationship between HRV and depressive symptoms in older inpatients undergoing rehabilitation. Fifty patients aged ≥65 years were assessed for depressive symptoms using the Geriatric Depression Scale. HRV was assessed by frequency analysis. The relationship between depressive symptoms and HRV indices, age, sex, Short Physical Performance Battery (SPPB) score, Mini-Mental State Examination score was examined using simple linear regression. Next, the predictors from the simple linear regression analysis significant at the 0.15 level were inputted in a multiple regression model. Multiple regression analysis revealed that very low frequency HRV [ β = -2.13, 95% confidence interval (CI) -3.15 to -1.11, P < 0.05] and SPPB score ( β = -0.30, 95% CI -0.52 to -0.08, P < 0.05) were negatively associated with depressive symptoms: the lower the HRV and the more severe the mobility impairment, the higher the severity of the depressive symptoms. Very low frequency (VLF) HRV and physical performance, as measured by the SPPB score, were associated with depressive symptoms in older patients undergoing rehabilitation. VLF HRV may serve as a useful biomarker for detecting depressive symptoms in this population.
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Affiliation(s)
- Go Owari
- Department of Rehabilitation, International University of Health and Welfare Narita Hospital
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare, Narita City
| | - Daiki Kanouchi
- Department of Rehabilitation, Inzai General Hospital, Inzai City, Chiba, Japan
| | - Masayoshi Uchiyama
- Department of Rehabilitation, Inzai General Hospital, Inzai City, Chiba, Japan
| | - Yusuke Nishida
- Department of Physical Therapy, International University of Health and Welfare, Narita City
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Liu C, Shi L, He J, Wang L, Min N, Wang F, Zhao M, Liu J, Zhang Y. Effects of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fracture. Asian J Surg 2023; 46:3687-3692. [PMID: 37422387 DOI: 10.1016/j.asjsur.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE To investigate the effect of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fractures. METHOD 102 elderly male patients with femoral neck fractures hospitalized in the Beijing Hospital from January 2017 to January 2019 were included. The patients with femoral neck fractures were divided into the depression group and the control group. The observation indicators included: bone mineral density, serum alkaline phosphatase, serum calcium, serum phosphorus, 25-hydroxy-vitamin D, osteocalcin, Type I procollagen amino-terminal propeptide, serum β-isomer of C-terminal telopeptide of type I collagen, hip function scores, and pain visual analogue scale at pre- and post-operative examinations. RESULTS The BMD was significantly lower in the depressed group than in the control group [either for lumbar spine or hip, P < 0.05]. Serum 25-(OH)-D levels and serum OC levels were lower (both P < 0.05) in the depression group, while serum -CTX levels were higher in the depression group than in the control group (P < 0.05). Depression severity (GDS score) was negatively correlated with BMD (r = -0.456, P < 0.05), 25(OH)D (r = -0.546, P < 0.05), and OC (r = -0.215, P < 0.05), while positively correlated with β-CTX (r = 0.372, P < 0.05). The Harris scores of the depression group were lower than the control group (P < 0.001). In the control group, VAS scores decrease at 12 months postoperatively while in the depressed group, VAS scores increased (P < 0.001). CONCLUSION Depression is a risk factor for low bone mineral density and fracture, and adversely affects functional recovery and pain relief after artificial femoral head replacement. Special care should be taken for those patients with depressive symptoms in orthopedic practice.
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Affiliation(s)
- Chi Liu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lei Shi
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jing He
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lin Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Nan Min
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Fei Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Maoyu Zhao
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Junchuan Liu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yaonan Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
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Gallego-González E, Mayordomo-Cava J, Vidán MT, Valadés-Malagón MI, Serra-Rexach JA, Ortiz-Alonso J. Functional trajectories associated with acute illness and hospitalization in oldest old patients: Impact on mortality. Front Physiol 2022; 13:937115. [PMID: 36187794 PMCID: PMC9515786 DOI: 10.3389/fphys.2022.937115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The literature pays low attention to functional changes during acute illness in older patients. Our main objectives were to separately describe the different functional changes occurring before and after hospital admission in oldest old medical patients, to investigate their association with mortality, and identify predictors associated with in-hospital failure to recover function.Methods: Secondary analysis of data from a prospective cohort study conducted in a tertiary teaching hospital. The study followed the STROBE criteria. The sample included 604 consecutive patients aged 65 or older hospitalized for acute illness, discharged alive, and not fully dependent at baseline. Activities of daily living measured at baseline, admission, and discharge were used to classify patients into four functional trajectories depending on whether they decline or remain stable between baseline and admission (prehospital) and whether they decline, remain stable, or recover baseline function between admission and discharge (in-hospital). Multivariate models were used to test the association between functional trajectories with mortality, and predictors for in-hospital recovery.Results: Functional trajectories were: “stable-stable” (18%); “decline-recovery” (18%); “decline-no recovery” (53%); “in-hospital decline” (11%). Prehospital decline occurred in 75% and 64% were discharged with worse function than baseline. “In-hospital decline” and “decline-no recovery” trajectories were independently associated with higher 6- and 12-month mortality. Extent of prehospital decline and dementia were predictors of failure to in-hospital recovery.Conclusion: In acutely ill older people, differentiating between prehospital and in-hospital functional changes has prognostic implications. Lack of functional regain at discharge is associated with higher mortality at 6- and 12-months.
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Affiliation(s)
- Eva Gallego-González
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Hospital Universitario HM Montepríncipe, Madrid, Spain
- *Correspondence: Jennifer Mayordomo-Cava,
| | - María T. Vidán
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | | | - José A. Serra-Rexach
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier Ortiz-Alonso
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
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Su SF, Lin SN. Effects of comprehensive geriatric care on depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence in older persons receiving hip-fracture surgery: A meta-analysis. Int J Nurs Pract 2022; 28:e13099. [PMID: 35978458 DOI: 10.1111/ijn.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/04/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence of comprehensive geriatric care in patients receiving hip-fracture surgery. BACKGROUND Hip fractures among older persons result in restricted activities of daily living, longer hospital stays, frequent emergency department visits and re-presentation to hospital, which may increase depressive symptoms and death risk. The benefits of comprehensive geriatric care have not been determined. DESIGN A five-step Cochrane collaboration meta-analysis was used. DATA SOURCES Randomized controlled trials published from 1980 to 2020 in which comprehensive geriatric care was provided following hip-fracture surgery were retrieved from the Cochrane Library, Clinical Key, Embase, MEDLINE, OVID and PubMed databases. Indicators were depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence. REVIEW METHODS The Group Reading Assessment, Risk of Bias 2.0 tool, modified Jadad scale and Comprehensive Meta-Analysis Version 3 software were used. RESULTS Overall, 1291 patients from six randomised controlled trials were included. Comprehensive geriatric care improved depressive symptoms and lowered emergency department visits but did not improve re-hospitalization rates or discharge to the same residence. CONCLUSION Comprehensive geriatric care should include depression management and individualized care plans. Further depression-related studies are required to verify their benefits.
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Affiliation(s)
- Shu-Fen Su
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Shu-Ni Lin
- Department of Nursing, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
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Grund S, Kilb M, Breitinger E, Hundsdörfer W, Schäfer HG, Schols JMGA, Gordon AL, Bauer JM, Alpers GW. Evaluation of a new screening instrument for psychological distress in postacute rehabilitation in older person. Eur Geriatr Med 2021; 13:243-251. [PMID: 34510385 DOI: 10.1007/s41999-021-00554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/11/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE Although psychological distress has a negative impact on functional recovery, institutionalisation and mortality rates, there is typically no established procedure to screen for psychological distress in geriatric rehabilitation. The aim of the study was to evaluate a brief single-item Verbal Numerical Rating Scale (VNRS-PD) as a screening tool for psychological distress in multimorbid geriatric rehabilitation patients. METHODS In this cross-sectional study, N = 132 geriatric rehabilitation in-patients (M = 82 years old; 70.5% female) completed a verbal numerical rating scale (VNRS-PD) on satisfaction with their mood as well as the Hospital Anxiety and Depression Scale (HADS) and the short-form of the Geriatric Depression Scale (GDS). Based on the questionnaire data, the rehabilitation patients were classified as high or low in psychopathology. Using receiver-operating characteristic (ROC) curve analysis, optimal cutoff scores of the VNRS-PD were calculated for each questionnaire to detect significant psychological distress. RESULTS Between 28.8% (HADS ≥ 18) and 43.9% (GDS ≥ 6) of the sample had above-cutoff questionnaire scores. The area under the curve (AUC) of the VNRS-PD varied from 0.785 (95%-CI 0.709-0.861) (GDS ≥ 6) and 0.790 (95%-CI 0.716-0.864) (HADS ≥ 18) to 0.807 (95%-CI 0.734-0.880) (GDS ≥ 7). A score of ≤ 5 in the VNRS-PD proved to be the cutoff with an optimal trade-off between sensitivity (0.776-0.867) and specificity (0.638-0.703). CONCLUSION The VNRS-PD may be a suitable screening instrument to detect patients with psychological distress in inpatient geriatric rehabilitation for and to initiate further diagnostics within a graduated psychodiagnostic scheme. This first step may help to identify older patients with psychological distress and mental disorders, to initiate targeted interventions. Further research is needed to replicate these findings in a larger sample.
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Affiliation(s)
- Stefan Grund
- Department of Geriatrics and Geriatric Rehabilitation, Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany.
| | - Michael Kilb
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Eva Breitinger
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Wilfried Hundsdörfer
- Diakonissen Hospital Mannheim Department of Geriatric Rehabilitation, Mannheim, Germany
| | - Hans G Schäfer
- Diakonissen Hospital Mannheim Department of Geriatric Rehabilitation, Mannheim, Germany
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,School of Health Sciences, City University of London, London, UK
| | - Jürgen M Bauer
- Department of Geriatrics and Geriatric Rehabilitation, Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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Executive Function Moderates Functional Outcomes of Engagement Strategies During Rehabilitation in Older Adults. Am J Phys Med Rehabil 2021; 100:635-642. [PMID: 34131093 DOI: 10.1097/phm.0000000000001739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined cognitive, affective, and medical impairments and their impact on rehabilitation approaches for improving functional outcome after hospitalization in older adults. DESIGN A secondary analysis of a randomized clinical trial in 229 adults 65 yrs or older admitted to two skilled nursing facilities undergoing rehabilitation services was conducted. Patients were randomized to receive physical and occupational therapy by therapists trained in systematic approaches to engage patients, called Enhanced Medical Rehabilitation, or standard of care. The outcome of interest was functional improvement, defined as Barthel Index at discharge (controlling for Barthel Index upon admission). This study analyzed the relationship of measures of cognition, depression, and medical comorbidities as predictors of functional outcome and as moderators interacting with treatment group. RESULTS Clock drawing score moderated treatment effect size; the functional improvement of Enhanced Medical Rehabilitation over standard of care therapy reduced with increasing executive impairment. In contrast, general cognitive abilities, depression, medical comorbidities, and readiness for rehabilitation were neither predictors nor moderators of functional improvement. CONCLUSIONS For older adults undergoing rehabilitation, greater functional improvement with the motivational techniques of Enhanced Medical Rehabilitation was contingent on patients having intact executive function. Given that executive function impairments are common in rehabilitation populations, new strategies are needed to improve treatment outcomes in physical/occupational therapy. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to (1) Discuss the role of baseline affective, cognitive, and medical impairments in impacting functional outcomes of older adults undergoing rehabilitation; (2) Describe the behavioral change and motivational approaches that are core features of the novel intervention known as Enhanced Medical Rehabilitation (E-MR); and (3) Determine the role of baseline executive function in moderating the effect of rehabilitation intervention on functional outcomes in older adults. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Zhu Y, Jayagopal JK, Mehta RK, Erraguntla M, Nuamah J, McDonald AD, Taylor H, Chang SH. Classifying Major Depressive Disorder Using fNIRS During Motor Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2020; 28:961-969. [DOI: 10.1109/tnsre.2020.2972270] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ferrazzoli D, Ortelli P, Cucca A, Bakdounes L, Canesi M, Volpe D. Motor-cognitive approach and aerobic training: a synergism for rehabilitative intervention in Parkinson's disease. Neurodegener Dis Manag 2020; 10:41-55. [PMID: 32039653 DOI: 10.2217/nmt-2019-0025] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) results in a complex deterioration of motor behavior. Effective pharmacological or surgical treatments addressing the whole spectrum of both motor and cognitive symptoms are lacking. The cumulative functional impairment may have devastating socio-economic consequences on both patients and caregivers. Comprehensive models of care based on multidisciplinary approaches may succeed in better addressing the overall complexity of PD. Neurorehabilitation is a highly promising non-pharmacological intervention for managing PD. The scientific rationale beyond rehabilitation and its practical applicability remain to be established. In the present perspective, we aim to discuss the current evidence supporting integrated motor-cognitive and aerobic rehabilitation approaches for patients with PD while suggesting a practical framework to optimize this intervention in the next future.
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Affiliation(s)
- Davide Ferrazzoli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Paola Ortelli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Alberto Cucca
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy.,The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY 10017, USA
| | - Leila Bakdounes
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
| | - Margherita Canesi
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
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Kelly-Pettersson P, Samuelsson B, Unbeck M, Muren O, Magnéli M, Gordon M, Stark A, Sköldenberg O. The influence of depression on patient-reported outcomes for hip-fracture patients 1 year after surgery: a prospective cohort study. Aging Clin Exp Res 2020; 32:247-255. [PMID: 31028625 PMCID: PMC7033144 DOI: 10.1007/s40520-019-01207-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is common in elderly hip-fracture patients and together with cognitive impairment is associated with increased risk of mortality. AIM We aimed to examine the influence depression has on patient-reported outcome up to 1 year after acute hip fracture. METHODS 162 hip-fracture patients participated in the prospective observational cohort study and were followed up at baseline, and 3 and 12 months using patient-reported outcome scores. Patients with cognitive impairment were excluded. Depression was defined as a score ≥ 8 on the depression subscale of the Hospital Anxiety Depression Scale (HADS D), having a diagnosis of depression or being treated with anti-depressant medication. Hip function was assessed using Harris Hip Score (HHS), EQ-5D was used to assess health status and Quality of life, and the Pain Numerical Rating Scale (PRNS) was used to assess pain levels. A linear regression model adjusted for group, age, sex, and ASA class was used to identify risk factors for functional outcome 12 months after fracture. RESULTS 35 patients were included in the depression group versus 127 in the control group. No statistical differences were found in the demographic data (age, sex, ASA class, fracture type, operation method, living situation, activities of daily living ADL and clinical pathway) between the groups. In the regression model, we found no correlation between depression and the patient-reported outcome. CONCLUSION In young elderly hip fracture patients without cognitive dysfunction, depression may not be of major importance for the rehabilitation of hip function in the short term.
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Affiliation(s)
- Paula Kelly-Pettersson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bodil Samuelsson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olav Muren
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Martin Magnéli
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Max Gordon
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - André Stark
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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Chang HY, Fang HL, Ting TT, Liang J, Chuang SY, Hsu CC, Wu CY, Pan WH. The Co-Occurrence Of Frailty (Accumulation Of Functional Deficits) And Depressive Symptoms, And Its Effect On Mortality In Older Adults: A Longitudinal Study. Clin Interv Aging 2019; 14:1671-1680. [PMID: 31631988 PMCID: PMC6775497 DOI: 10.2147/cia.s210072] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose The co-occurrence of frailty and depression in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality have rarely been investigated. We aimed to examine the co-occurrence of frailty and depressive symptoms in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality using all the information from a longitudinal study. Patients and methods We used the Taiwan Longitudinal Study of Aging (TLSA) for this study. TLSA was initiated in 1989 and followed periodically. We included participants from 1989 to 2007, who had data on frailty and depressive symptoms. Frailty was assessed by accumulation of functional deficits in 6 dimensions including disease status, sensory dysfunction, balance, functional limitations, health risk behaviors, and life satisfaction. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). A multistate model with interval censoring was used to examine the transition between states of frailty with or without depressive symptoms, and finally to death. A mixed model was used to examine the relationships between frailty and depressive symptoms. Results The coexistence of frailty and depressive symptoms was associated with higher mortality. Individuals with depressive symptom had a lower probability of reversal to a better state. Previous depression score predicted current frailty, but the coefficient was smaller than that of previous frailty. Previous frailty predicted current depression score, and the coefficient was stronger than that of previous depression. Conclusion Depressive symptoms increased the mortality and decreased the probability of reversal in the frail older adults.
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Affiliation(s)
- Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Ling Fang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Te-Tien Ting
- School of Big Data Management, Soochow University, Taipei, Taiwan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Chin-Yin Wu
- Institute of Sociology, Academia Sinica, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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Mas MF, Mathews A, Gilbert-Baffoe E. Rehabilitation Needs of the Elder with Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2018; 28:829-842. [PMID: 29031347 DOI: 10.1016/j.pmr.2017.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of traumatic brain injury (TBI) in older adults is increasing. As the expected life expectancy increases, there is a heightened need for comprehensive rehabilitation for this population. Elderly patients with TBI benefit from rehabilitation interventions at all stages of injury and can achieve functional gains during acute inpatient rehabilitation. Clinicians should be vigilant of unique characteristics of this population during inpatient rehabilitation, including vulnerability to polypharmacy, posttraumatic hydrocephalus, neuropsychiatric sequelae, sleep disturbances, and sensory deficits. Long-term care should include fall prevention, assessment of cognitive deficits, aerobic activity, community reintegration, and caretaker support. Life expectancy is reduced after TBI.
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Affiliation(s)
- Manuel F Mas
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030, USA.
| | - Amy Mathews
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Suite 10C, Houston, TX 77030, USA
| | - Ekua Gilbert-Baffoe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Suite 10C, Houston, TX 77030, USA
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Almomani FM, Bani-issa W. The incidence of depression among residents of assisted living: prevalence and related risk factors. Clin Interv Aging 2017; 12:1645-1653. [PMID: 29070943 PMCID: PMC5640406 DOI: 10.2147/cia.s147436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This study aims to recognize and estimate the prevalence of depression and its risk factors among residents of assisted living facilities (ALs) in Jordan. BACKGROUND Depression is commonly experienced by residents of ALs. The condition is, however, often misunderstood as a part of normal aging and may be overlooked by health care professionals. Little is known about the extent of depression and its risk factors among AL residents in Jordan. SUBJECTS AND METHODS A national representative sample of 221 residents selected from all AL units across Jordan was recruited to the study. Data on expected risk factors for depression were collected, including sociodemographics; smoking status; number of roommates; number of family members; assessments for cognitive functioning, for lower limb functioning, for hand, shoulder, and arm impairments; and oral health status. Levels of depression among the sample respondents were also assessed. RESULTS The study found that around 60% of the participants reported depressive manifestations, with 48.0% of AL residents exhibiting impaired cognitive functions, one-third (33.2%) having >50% upper limb disability, two-thirds (63.2%) being at moderate risk of falls, and 69.7% having fair to poor oral health status. Being female, and having a higher level of education, disability of the upper limbs, and impairment of cognitive functions were found to be independent risk factors for depression in participants. CONCLUSION Depression is relatively common among residents of AL units in Jordan. Health care professionals, nurses, physiotherapists, and dentists working in these facilities need to work cooperatively to identify the manifestations of depression in residents and collaboratively implement the best practice in the treatment of depression and circumvent its long-term impacts on the health of residents.
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Affiliation(s)
- Fidaa M Almomani
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Wegdan Bani-issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Lac A, Austin N, Lemke R, Poojary S, Hunter P. Association between religious practice and risk of depression in older people in the subacute setting. Australas J Ageing 2017; 36:E31-E34. [PMID: 28319319 DOI: 10.1111/ajag.12384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify the association between religious practice and risk of depression in older people admitted to a subacute hospital. METHODS A cross-sectional survey was conducted with 100 patients aged ≥65 years with Mini-Mental State Examination (MMSE) scores ≥24 consecutively admitted to a subacute hospital. Religious practice was measured using the Duke University Religion Index and risk of depression using the 15-item Geriatric Depression Scale (GDS). RESULTS Geriatric Depression Scale was significantly correlated with intrinsic religiosity (r = -0.21, P = 0.04) and cognition (r = -0.22, P = 0.03). CONCLUSION This cross-sectional study of older people in a subacute setting found depression scores were negatively and independently associated with both intrinsic religiosity and cognition. In conjunction with cognitive assessment, health professionals working with older people may consider taking a spiritual history as part of holistic care.
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Affiliation(s)
- Alice Lac
- Department of Geriatric Medicine, Peninsula Health, Melbourne, Victoria, Australia
| | - Nicole Austin
- Clinical Innovation and Interdisciplinary Projects, Caulfield Hospital, Melbourne, Victoria, Australia
| | - Renata Lemke
- Aged Care Department, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
| | - Suma Poojary
- Aged Care Department, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
| | - Peter Hunter
- Aged Care Department, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
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